'My mother apologised': A survivor's journey after genital mutilation

Sara Kahsai grew up in Sudan but moved to Birmingham, England, in 2022 after a marrying a bus driver from the city.

But as she settled into married life and her new home, she was coming to terms with a life-changing discovery.

Sara realised she was a victim-survivor of Female Genital Mutiliation (FGM), a procedure she had endured as a young girl.

She was floored by the revelation and, not least, the excruciating pain she was now beginning to fully understand.

"The shock was massive," she said.

"It made it difficult with my physical relationship with my husband - but he was very kind and very patient with me."

Warning: This story contains descriptions of the practices involved in female genital mutilation

Sara turned to the one person she knew must have orchestrated it - her mother - and asked her why.

"I was a baby. It was the culture to do it for everybody," she said her mother, still living in Africa, told her.

"When I spoke to my mum she was really upset and she apologised to me."

FGM involves the partial or total removal of female genitalia for non-medical reasons, and is practiced in some parts of Africa, the Middle East and Asia.

It also happens within some migrant communities in the UK, where it is illegal and treated as child abuse. It is also against the law to take a girl abroad for FGM.

Reasons include social acceptance, religion, misconceptions about hygiene and preserving a girl or woman's virginity.

The Home Office website cites World Health Organisation figures showing three million girls undergo some form, external of the procedure every year in Africa alone.

When Sara fell pregnant, she finally told health professionals she had endured FGM as a child.

She was immediately referred to the specialist FGM Clinic, run by midwives at Birmingham Women's Hospital.

Midwife Renata Hanif deals with around 200 cases each year and says her job is to ensure the wellbeing of women and safeguard unborn children.

"Some types of female circumcision can affect the vaginal delivery," she said.

They offer deinfibulation - a procedure that can be carried out during pregnancy that to separate fused tissue and enable safer births.

Victim-survivors of FGM can also experience difficulty with urinating and menstruating, the midwife said.

Women are more prone to infections and sepsis, and can suffer from severe and ongoing pain, as well having to deal with psychological trauma, anxiety and depression.

Many patients find it hard to talk to her about what's happened to them, Hanif said.

"It is very difficult, very emotional. It's very difficult for the woman to actually come forward and to come to the clinic, attend the clinic, and have a conversation with me as well," she said.

"I explain to them that I'm here to help and I try to explain to them what happened to them when they were a child."

She said most women leave the clinic with a better understanding of how they have been affected and how they can take back control of their bodies.

"We talk about every part, what that part is there for and what's been removed and what cause for concern and what effect this will have for the rest of her life," Hanif said.

Counselling is also offered as well as information on how partners and husbands can support them.

In 2015, children's charity Barnardo's set up the National FGM Centre to help better protect women and girls.

It works to prevent FGM, raise awareness of it and support those affected.

The centre said schools are legally required to teach pupils about FGM and the law surrounding it as part of relationships and sex education.

But how it is delivered can vary between schools. It's also not mandatory for it to be taught in primary schools and they want to see that change.

"For us, a huge part of tackling FGM is prevention," Roma Ullah, from the centre, said.

"Yes, a conviction, a prosecution, can provide justice, accountability and send strong messages into communities, but by then the harm has already happened."

In April, the government held its first dedicated FGM Summit in a decade, to discuss ways to better protect women and girls.

Among improvements on the way are new guidelines to help identify girls at risk of being taken abroad for FGM.

Sara wants to urge other women in a similar position to take immediate action.

"I have a message to all ladies who've had FGM," she said.

"When they come to the UK it is different. There's help here - go to their GP, seek help, ask for help.

"If I knew I could seek help I would not have waited until I was expecting... because I did suffer a lot before."